Health Insurance System
List of Insurance Benefits
List of Insurance Benefits for Individuals (Insured Persons)
Illness or Injury
| Treatment benefit | 70% of the medical expenses for both out-patient and in-patient care |
|---|---|
| Treatment benefit (Individuals age 70 to 74) |
80% of the medical expenses for both out-patient and in-patient care *However, this is 70% for individuals age 70 to 74 who are income earners comparable to active service.
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| Expenses for combined covered/non-covered medical care | 70% of the medical expenses for treatment within the scope of health insurance if combined with non-covered treatment |
| Medical treatment expenses | Standard amount of reimbursement for claims to the Mercari Health Insurance Association after paying expenses out of pocket |
| High-cost Medical Care Expenses | Amount exceeding out-of-pocket medical costs for one treatment per month when above the maximum amount (the maximum amount differs for low-income earners and individuals age 70 to 74) |
| Aggregated High-cost Medical Care Expenses | Amount exceeding the combined maximum total of 21,000 yen in out-of-pocket costs for two or more cases in the same household for the same month |
| Amount of co-payment reductions and additional aggregated high-cost medical expenses (additional benefits) | Payment of an amount calculated by deducting 20,000 yen from the out-of-pocket amount (amounts less than 1,000 yen will not be paid; amounts less than 100 yen are rounded down) |
| High-Cost Long-Term Care Combined Medical Expenses | Excess amount proportionally divided according to the ratio of medical and long-term care expenses if the combined total of out-of-pocket payments of medical and long-term care expenses for one year exceeds the maximum limit |
| Subsidy for ｍeals during hospitalization and Subsidy for living expenses during hospitalization |
Meal expenses exceeding 510 yen for each meal for up to three meals per day; the amount of residence expenses exceeding 370 yen per day in cases of in-patient daily living treatment expenses *There are measures available to mitigate the burden on low-income earners.
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| Home Healthcare Service Expenses | 70% of the stipulated expenses |
| Additional home-visit nursing care expenses (additional benefits) | Payment of an amount calculated by deducting 20,000 yen from the out-of-pocket amount (amounts less than 1,000 yen will not be paid; amounts less than 100 yen are rounded down) |
| Transfer Costs | The actual expenses within the range of the standard amount calculated by the Mercari Health Insurance Association |
Incapacity to Work Due to Illness or Injury
| Injury and sickness allowance | Amount equivalent to two-thirds per day of leave [average standard monthly remuneration for the last 12 months divided by 30] for 18 months, counting the total number of days paid |
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Childbirth
| Childbirth Allowance | An amount equivalent to two-thirds per day of leave [average standard monthly remuneration for the last 12 months divided by 30] for 42 days before childbirth (98 days for twins or other multiple births; payment also provided for any period childbirth is delayed from the due date), and 56 days after childbirth |
|---|---|
| Childbirth Allowance Supplement | For each day of leave, we will pay an amount equal to 85/100 of the average of the standard monthly remuneration for the 12 consecutive months prior to the month in which the maternity allowance begins (limited to those established by the insurer to which the insured person belongs) minus the amount of the applicable maternity allowance. |
| Childbirth and Childcare Lump-sum Allowance | 500,000 yen per child (488,000 yen if birth took place before 22 weeks or the individual gave birth at a hospital or other medical institution that is not a member of the Japan Council for Quality Health Care) |
| Childbirth and Childcare Lump-sum Allowance (Additional Benefits) | 90,000 yen per child |
Death
| Funeral Expenses (Fees) | Uniform 50,000 yen |
|---|---|
| Burial fees additional amount (additional benefits) | Uniform 150,000 yen |
List of Family (Dependent) Benefits
Illness or Injury
| Dependents' medical care expenses | 70% of the medical expenses for both out-patient and in-patient care |
|---|---|
| Dependents' medical care expenses (pre-school children and individuals aged 70 to 74) |
80% of the medical expenses for both out-patient and in-patient care *However, this is 70% for individuals age 70 to 74 who are income earners comparable to active service.
|
| Expenses for combined covered/non-covered medical care* | 70% of the medical expenses for treatment within the scope of health insurance if combined with non-covered treatment |
| Medical treatment expenses* | Standard amount of reimbursement for claims to the Mercari Health Insurance Association after paying expenses out of pocket |
| High-cost Medical Care Expenses | Amount exceeding out-of-pocket payments of medical expenses in a single month exceeding the stipulated amount (there are also measures to mitigate the burden, such as totaling amounts for the entire household) |
| Aggregated High-cost Medical Care Expenses | Amount exceeding the combined maximum total of 21,000 yen in out-of-pocket costs for two or more cases in the same household for the same month |
| Additional family medical expenses and Additional aggregated high-cost medical expenses (additional benefits) | Payment of an amount calculated by deducting 20,000 yen from the out-of-pocket amount (amounts less than 1,000 yen will not be paid; amounts less than 100 yen are rounded down) |
| High-Cost Long-Term Care Combined Medical Expenses | Excess amount proportionally divided according to the ratio of medical and long-term care expenses if the combined total of out-of-pocket payments of medical and long-term care expenses for one year exceeds the maximum limit |
| Subsidy for ｍeals during hospitalization and Subsidy for living expenses during hospitalization* |
Meal expenses exceeding 510 yen for each meal for up to three meals per day; the amount of residence expenses exceeding 370 yen per day in cases of in-patient daily living treatment expenses *There are measures available to mitigate the burden on low-income earners.
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| Family home-visit nursing care expenses | 70% of all stipulated expenses |
| Additional home-visitnursing care expenses (additional benefits) | Payment of an amount calculated by deducting 20,000 yen from the out-of-pocket amount (amounts less than 1,000 yen will not be paid; amounts less than 100 yen are rounded down) |
| Dependents's Transportation Expenses | The actual expenses within the range of the standard amount calculated by the Mercari Health Insurance Association |
*When expenses for combined covered/non-covered medical care, treatment expenses, in-patient dietary treatment expenses, or in-patient daily living treatment expenses are paid to a dependent, these benefits are paid as dependents' medical care expenses.
Childbirth
| Dependents' Childbirth and Childcare Lump-sum Allowance | 500,000 yen per child (488,000 yen if birth took place before 22 weeks or the individual gave birth at a hospital or other medical institution that is not a member of the Japan Obstetric Compensation System for Cerebral Palsy) |
|---|---|
| Dependents' Childbirth and Childcare Lump-sum Allowance (Additional Benefits) | 90,000 yen per child |
Death
| Funeral expenses for a family member | Uniform 50,000 yen |
|---|---|
| Burial fees additional amount (additional benefits) | Uniform 150,000 yen |